Social Care: A Culture of Unimportance

The Government’s Winterbourne View final report talks of a ‘culture of abuse’ being allowed to flourish within the establishment. This is nothing new there have been plenty of cases where this has happened and many commentators have mentioned this, we have periodic exposes of abusive culture within social care settings followed by a brief blustering of politicians yet these things keep happening.

The real issue that needs to be addressed in adult social care is the culture of unimportance that pervades society when it comes to the needs of the elderly and disabled in the country.

                                          

The Winterbourne report highlights this culture of unimportance. There is no Prime Ministerial forward promising whole Government action, there is not even a signature from the Cabinet Minister for Health. This should not distract from many of the good proposals in the report yet it, in terms of promoting social care as a national important area of policy it fails.

This is, obviously, only the latest in the line of things were the Government continues to cultivate the culture of unimportance around adult social care. The Dilnot Commission , set up as part of the coalition agreement,  submitted its final report in July 2011 and, since then, has largely been scrupulously avoided aside from the odd burst of political gusto when it seemed convenient. In the meantime the reality for many older people remains the same, sell your house to pay for your care.

Naturally Dilnot is itself a product of the culture of unimportance. The Commission was set up to tackle only how care is paid for, what has not been tackled is the ever tightening eligibility criteria for state support with care nor has the needs of other vulnerable adults, such as those with learning disabilities, had any consideration.

The social care culture of unimportance cannot just be ascribed to this Government, the previous Labour Government prevaricated and delayed taking action on social care producing a White Paper on 30 March 2010 just weeks before an inevitable General Election, and even then their ideas where merely a tinkering of what already existed rather than wholesale reform.  

The culture of unimportance that is allowed to flourish at Westminster inevitably and naturally trickles down to the rest of society. Undoubtedly if many average people in the street were to be asked what has been the most important issue discussed at Westminster this week the answer, inevitably, will be that of same sex marriage. While that is important in its own right surely the needs of the most vulnerable in society should take precedence and, although I don’t know the exact numbers, I suspect that the issue of same sex marriage will have a direct impact on far fewer members of the population than social care reform would.

The culture of unimportance MUST end and social care must take its rightful place alongside the other major areas of social policy. As society continues to age the implications for social care are significant, more and more people will need social care services and it is societies duty to ensure those needs are met.

Personally I feel it is obviously right that social care should have its own Cabinet Minister and Department for Social Care and have started a e-petition to this effect (click here to sign) as I believe that this will be a start to raising the importance of social care nationally. Yet beyond this we do need those in charge now to stop treating social care as a side issue to other areas of social policy and start treating social care with the importance it needs in order to ensure the well-being of the millions who need social care services.

Back to Basics after Winterbourne View: Social Care Training

The Governments final report on Winterbourne View says a lot about the need for staff training but within all of that there is an important phrase that applies right across the social care spectrum and that phrase is “properly trained”.

While there could be some debate about what ‘properly trained’ means it is essential that all care providers reflect on the standard of training that they are providing for their staff. Under the current economic climate it is quite possible that providers are focusing on the cost rather than the quality of training.

Skills for Care and Skills for Health are charged with producing minimum training standards by January but it is unclear as yet whether these will be tick boxes for providers or fundamental changes in the way training must be monitored or delivered yet in either instance care providers should take responsibility for the quality of the training they provide for their staff and this can be done in a number of ways.

Firstly talk to staff. How did they feel about the training, were they engaged with the training or was it just a chore that just had to be done? I know, from personal experience, have conversations like that are useful, once I was informed that a training session was pointless because the trainer just read everything from a book and obviously did not know much about the actual subject. Needless to say that training provider was not used again but without seeking that feedback in the first place the company would probably have continued using the same trainer.

Naturally it would be obviously more useful if care providers could have some assurance about the quality of training providers before they booked them. This is easy for certain courses such as First Aid and Food Hygiene where trainers are accredited by the Chartered Institute of Environmental Health but for other training the route to quality is much less clear.

Yet there is some help, the National Skills Academy for Social Care has started a list of endorsed trainers (available here) and of course word of mouth through local trade associations is a good way to identify recommended trainers. Hopefully the endorsement/registration of trainers in social care will expand to help providers in identifying trainers who can provide appropriately qualified trainers to meet the needs of their particular service.

It is also, perhaps, important that care training providers look at how they can improve their own service by , perhaps, ensuring that the model of care set out in the Winterbourne View report is embedded in any training they deliver and by seeking recognition from the National Skills Academy for Social Care so that providers can trust that they will receive quality training.

Care providers have further responsibility though. Ensuring staff are ‘properly trained’ is not just about what happens in the classroom setting, that training has to be turned into practice and that aspect is the responsibility of the management of the care provider. How aspects such as infection control, medication, mental capacity, adult protection etc. are applied to those the provider cares for can only be done at the point of care delivery and it is essentially vital the staff development activities work hand in hand with formal training.

Unfortunately, when the sector changed from the National Minimum Standards to the Essential Standards of Quality and Safety many of the training standards were lost as the new standards were required to cover hospitals, dentists, ambulance services etc. as well as social care but hopefully the new standards being worked will fill some of this gap.

There can be little doubt that training and the quality of training will be high in the Care Quality Commission inspection agenda and ultimately training provision is the responsibility of the care provider and it is essential that training provided for staff is high quality training that engages and leads to better outcomes for those they provide services for.

Winterbourne View Report: Smoke & Mirrors?

Any action to improve the lives of those with learning disabilities has to be welcome and many of the proposals in the Governments Winterbourne View Final Report are good yet that does not mean the report should go unchallenged especially as there are some inconsistencies where it appears the Government may be trying to deflect responsibility introducing ideas that, actually, really already exist.

Norman Lamb and others have focused a lot on corporate responsibility. Norman Lamb said “This case has revealed weaknesses in the system’s ability to hold the leaders of care organisations to account. This is a gap in the care regulatory framework, and we intend to close it”.

In fact the Health and Social Act 2008 made care organisations accountable and open to prosecution if they fail to meet the regulations, and Castlebeck certainly failed on a number of them. The Care Quality Commission also has the power to cancel a providers registration. In addition there are also the legal requirements under the Health & Safety Act 1974, the HSE’s guidance states:

“Recent case law has confirmed that directors cannot avoid a charge of neglect under section 37 by arranging their organisation’s business so as to leave them ignorant of circumstances which would trigger their obligation to address health and safety breaches.
Those found guilty are liable for fines and, in some cases, imprisonment.”

As the abuse at Winterbourne View clearly breaches the Health & Safety requirement to keep everyone in the place of business safe, surely Castlebeck should have been prosecuted.

Rather than taking time to draft new legislation surely it would make more sense to ensure existing legislation is being used effectively.

We also need to take care over how the Government frames the action which it proposes to take, for example in its timetable for action we have:

From June 2012 – CQC will take enforcement action against providers who do not operate effective processes to ensure they have sufficient numbers of properly trained staff, &;

From April 2013 – CQC will assess whether providers are delivering care consistent with the statement of purpose made at the time of registration
Although welcome moves the real question, unanswered by the report, is why were these not already happening? Both are required by the Health & Social Care Act regulations and, as such, form part of the requirements of registration. Yes there has been a change of leadership at the CQC and things have improved but it does not mean that such things should be omitted from the report nor does it excuse the absence of any action to ensure such things do not happen again.

The report also fails to answer the question of Government inaction on social care, particularly in terms of those with Learning Disabilities where the principles of Valuing People seemed to have faded in to dim memory. Much of what is being proposed should already have been in place and it is the Governments neglect of social care that means they are now only acting because they are forced to.

There is also a serious omission from the report that is equally important to the Winterbourne View case and that is Whistleblowing. Action could have been taken much sooner if the reports to Castlebeck and CQC were acted upon and some of the abuse witnessed in the Panorama film would not have happened. Yet nowhere in the list of action to be taken is a review of existing Public Interest Disclosure law, the responsibilities of statutory bodies to act or even report when abuse is alleged.

For all the effort to prevent abuse it is still down to people reporting it before it can be truly uncovered, I doubt very much if regulatory bodies have uncovered abuse through annual inspections, and therefore there has to be much more done in the way of encouraging people to disclose abuse along with a much more robust response when such reports are made that reports all allegations not just those that make it to safeguarding referral stage.

It would be wrong throw out the baby with the bath water and there are some very positive proposals in the report. It is right to end the existence of these pseudo-hospitals and it is right to move all people with learning disabilities toward person centred support.

We need more action on learning disability services and not just for those who find themselves confined in so called hospitals. Abuse happens in other places to and we need equal action to eradicate hate crime in the community where life is not regulated by the CQC.

This report should just be a start, let's have a new white paper on how the Government and society will support those with Learning Disabilities to lead fuller and safer lives.

Compassionate Government - Bah Humbug

This week’s Autumn Statement from the Chancellor seems to finally put paid to any pretence of ‘compassionate conservatism’ as, subtly he put social care under increasing economic pressure and impacted on the lives of the millions who need social care services to help them in their everyday lives.

There were multiple blows to social care, none of which actually identified it but the implications are there and the vulnerable in society will suffer from the impact.

Firstly there was central Government spending. George Osborne announced that all Westminster departments will need to cut spending further. There were only a few exceptions, his own department HMRC, education and the NHS. There is an important distinction here, as the NHS is not the whole of the Department of Health and the social care side of the DH looks like it will have to reduce spending in line with the cuts made across other departments meaning less money to essential front line services.

On top of this local authority spending will have to be cut further. Back in October the President of the Association of Directors of Adult Services warned the care services were on the edge (see here) and the prospect of extra cuts can only mean those vital services may tip over the edge as less and less people either fall out of eligibility criteria or services become so time orientated that any form of personalised care goes out the window.

Yet the cuts to local authority spending will have a secondary impact. Under the health reforms the responsibility for public health functions was transferred to local authorities including things such as health protection, public health initiatives to tackle social inclusion, initiatives to reduce seasonal mortality rates, public mental health services and many more which have a direct impact on the lives of those who need social care services.

The real irony is that investment in social care and public health could actually be more beneficial to the NHS budget than simply ring-fencing that alone. It is well documented that prevention services mean less need for hospital admissions etc, people prefer to remain at home during illness and home care with preventative public health services can increase the likelihood of that.

So the Autumn Statement proposals are not just punitive punishment on those who need social care services but they are also false economics.

The other aspect of social care overlooked by the Government is the fact that not all people who need social care services are over the age of 65. Many people with learning disabilities receive ordinary benefits which have now been capped meaning an increasing number will fall further into poverty. The Foundation for People with Learning Disabilities stated that only 7% of people with learning disabilities are in employment yet 65% want a job. It is unfair to label these people as shirkers when it is the Government’s failure to create an economic climate that creates full-time jobs.

In addition to all of this we have the lack of action on social care funding in general, it has been nearly 18 months since the Dilnot Commission submitted its final report yet still nothing has happened, the urgency with which the Government launched the commission has totally and utterly turned into a lethargy of inaction.

There are millions of people with social care striving to make life as bearable as possible yet the shirkers in Westminster seem to determined to make that as hard as possible.

Residential Care Providers Outperform the NHS.

Residential Care providers outperform the NHS.

That is, of course, a blanket statement but backed up by the State of Care report published by the Care Quality Commission last week. The headline figure when the report was published was the fact that 15% of hospitals failed to meet the standards on making sure patients had the right food and drink and the help they needed, yet for residential care – i.e. non-nursing care - the figure was 11% of homes failing to meet these standards.

It was not just this standard that saw a difference. On meeting standards on respect and involvement 9% of NHS hospitals failed to meet this standard compared to 7% of residential care homes and on meeting standards of effective care, treatment and support 19% of NHS hospitals failed to meet the standards compared to 18% of residential care homes.

Obviously this is a very simplistic and selective view, in general, nursing homes were worse than hospitals and the complexity of health service provision is different from that of a residential care home.

Yet these figures should not be totally ignored and lessons must be learnt.

The health service must, for a start, consider what it can do to improve performance and what it can do too learn from the residential care providers which outperformed it in a number of areas. Why are residential care providers better at providing food and drink, what lessons can be learned in improving respect and involvement. There has to be a system in place where the NHS can draw on the best practice of social care to improve its performance with its patients.

There must also be a look at the significant difference in performance between nursing and non-nursing residential care where the contrast is quite startling. In nursing homes 20% failed to meet the nutrition standards, 15% failed on respect and involvement and 28% failed on effective care, treatment and support. In just about every standard nursing care fell behind residential care the most surprising of which was management of medicines where 33% of nursing homes failed to meet the standard compared to 26% of residential homes – surprising because nursing care should have trained nurses on their staff whereas this is not necessary in purely residential care.

The Care Quality Commission report gives us a snapshot of the state of care but we need now to act upon its findings and this is where we need national leadership to make improvements.

The fragmented nature of social care provision, around 25,000 different nursing and residential care homes providing services across 152 councils with social services responsibilities, means that there is little coordination over the country to draw together what lessons can be learnt from the report, how to implement the changes needed and how to engage with the vast myriad of providers to ensure ‘best practice’ becomes the social care standard.

The fragmentation of social care means that those at the top can frequently pass the buck and abrogate responsibility but with the increasing need for social care as the population ages and the increase in the complex needs of social care users we, as a nation, need those in Westminster to take full responsibility for the services provided to the vulnerable in the country.

The route to improvement is learning, learning where the failures are and learning the best way to decrease those failures. The system is never going to be perfect but we need national leadership to reassure the public that all possible action is being taken to ensure health and social care provision the best it can be and the lives of ALL those who need care services are paramount in that.

A Few Words about Words

A word about words or maybe a brief discourse on discourse, how language is used is important in society and we have a debate now on how Dementia is referred to (see the excellent D4Dementia Blog).

Despite Shakespeare’s words, “a rose by any other name would smell as sweet”, if a rose was called a manure fed weed, chances are that you would not even bother trying to smell it in the first place!

Sometimes the changes to words we use to label something are good, we only have to look at the term learning disability, previously known as mentally handicapped, mentally retarded (mental retardation is still used in the U.S.A.), feeble mindedness etc. and we have the evolution of the label lunatic to mental health issues. In such instances re-labelling the terms we use reduce the stigma attached to the old ones and can help toward promoting a more positive image of individuality.

Many times labels are used by those in power to delineate ‘us from them’, the classic example being a terrorist in one state can easily be called a freedom fighter in another. Governments re-label in different ways constantly, usually as way of marking out their difference from the previous one – for example the Department for Children, Schools and Families was quickly relabelled the Department of Education when the current Government came to power, the functions are largely the same but the idea is to display the current ideology in the Ministerial office.

Labels also change as a form of aggrandisement, for example in job titles where those who collect our rubbish are now waste management technicians or those trying to sell us insurance become Financial Security Consultants, equally labels can be used to demonise and stigmatise where they become stereotypes in order to pit one section of society against another.

Whatever the reason for changing labels and the way we talk about things is, ultimately, about changing perceptions of how people in society view something.

What it rarely does is change the reality of what happens. Waste management technicians still collect our rubbish on a regular basis, the violent actions of an individual whether they are a freedom fighter or a terrorist remain the same and Ministers still sit in comfortable offices whatever the name of their department at the time.

So those with dementia or neurocognitive disorder, will suffer the same symptoms, require the same level of care and support and families will live through the same fears no matter what the condition is labelled with. Yet what about further up the social care ladder?

As the cases of dementia continue to grow as the population ages what difference will the label ‘disorder’, rather than disease, make to those holding the purse strings of care and support. It would be interesting to test public perception of the two words and see which is considered more worthy of tax payer money and how politicians in power would change their policies dependent on the word used. Many have campaigned to have dementia recognised as a disease in order to receive proper health funding for those who suffered from it, where does the word disorder leave their efforts?

It is also important to consider the people who actually suffer from it. Throwing new terminology at a person with cognitive decline and probable short term memory problems does seem foolish. One of the keys to personalised care and support is using language which is familiar to the individual and be changing terminology in can confuse and bewilder, especially when the new terminology is particularly vague, after all neurocognitive disorder could easily be interpreted as the result of a head injury, or more connected with mental health issues, something in the realm of psychiatry rather than the physiological needs that can be associated with dementia. In the wider world the public are more aware of dementia than ever before, throwing in new terminology muddies the waters at a time when increasing awareness is needed.

Words are important and the way we use language has an impact on how society as a whole perceives something yet the most vulnerable in society, those with dementia or those with learning disabilities will always have some difficulty in grasping new labels attached to conditions they may have which in turn can further confuse and bewilder them.

Although the possible changing name of dementia has sparked this debate it does not just apply to that, anything we re-label, any terminology we use can cause confusion amongst those who need clear, precise and understandable language to support them in their day to day lives. Whatever the reason for wanting to re-label dementia those who wish to do so should consider how their new terminology will improve lives for individuals and if it does not, why bother?

Social Care Users are Not All Elderly

Half a million people under the age of 65 receive council funded social care services. That is around a third of all those receiving services and there is a danger they become excluded in the wider social care debate.

We have seen some excellent initiatives in dementia recently, albeit maybe not going quite far enough, but we need the social care debate to encompass all those who need societies support in life. The funding debate in social care has almost exclusive focused on the Dilnot proposals and how elderly care is paid for. How much should older people contribute to care they receive, what should be the threshold for capital etc. This debate has little to with those under the age of 65.

Similarly we have seen the debate of health and social care integration. There is no doubt that the two are related but more so in relation to elderly care than the support needed for those under 65. Those with physical or learning disabilities and those with mental health issues do need support in health but they need support in daily life, support with housing needs and support with employment and welfare in order to live as independently as possible.

The number of those under 65 receiving council funded services has, in line with the general trend, declined slightly but this does not mean there are less people needing societies support, simply that the eligibility criteria for receiving support has tightened and the fact that support centres have closed because of the budgetary constraints on local authorities meaning less support being available to many.

As with all areas of social care there are many who do not appear on the statistics but that does not mean they are any less deserving of societies support. In addition there are many families who provide support for individuals who also need our help. The changes in demographics and the ageing nation applies to those with physical and learning disabilities as it does to the general population and there are an increasing number of elderly parents still caring for a child without the support of society.

Social care is wider than just health and should be treated as equally as any other area of social policy.

The health and social care integration debate and the focus on elderly care detracts from this wider function of social care and marginalises those who are under 65 and who need more than just health support in social care settings.

We need to raise ALL social care into the spotlight and social care needs to have the same Government input as Education, Welfare, Health and Employment therefore it needs a cabinet minister for social care as this will put it on an equal footing with these other areas of social policy.

Please take the time to sign my e-petition calling for a Cabinet Minister for Social Care - http://epetitions.direct.gov.uk/petitions/39701

YOU are getting older ACT NOW

One in three people over the age of 65 will die with some form of dementia (Alzheimer Research UK).

Given the latest statistics suggest that there are over 10 million currently over that age in the UK we are looking at around 3 million people having dementia, as the population grows and ages this means dementia will impact on even more people in the future.

Big numbers generally make our minds switch of, the bystander effect kicks in and we just assume it is someone else’s problem, not our responsibility and best left to ‘professionals’ to deal with. Yet we need to put the issue into perspective.

But if you stop and break it down a bit can we afford to be bystanders?

How many brothers or sisters do you have? I have three, so the chances are that between the four of us at least one will develop dementia. A daunting thought and enough to make me think that action needs to be taken now so if I, or anyone else in my family, develops dementia the best possible care and support is available. Although many would like to deny it we all age and as we age we creep closer to being the one in three who will develop dementia and if we do not have the infrastructure in place what sort of care and support we will receive.

Think about your future as you age. You may develop dementia or you may find someone you love develops it and you have to be their primary carer. The issue may not even be dementia, other conditions such as Parkinson’s disease or long term heart conditions etc. Imagine being in a situation where you are unable to fully engage with your family or friends because you are physically unable to make even a simple cup of tea or having issues with continence that leaves feeling embarrassed or ashamed.

Stop, and start to ask yourself how well prepared in the country to provide YOU with the support and care you need later in your life.

As you think about your future also think about those who are in that situation now. There are millions caring for someone they love but without real support from society because they ‘fail’ to meet the eligibility criteria set by bureaucrats. Local authorities, who supply most social care funding are facing ever tightening budgets and services are declining because of this. Take time to think about the pressures on elderly people in the current economic climate where the costs of heating and food are climbing but help from the state is declining.

You are getting older, and as you get older there is an increasing likelihood that you will need social care support either for yourself or for someone you love. We are an ageing population and it is important for us to act now to secure our future and also those who need support services today.

We cannot be bystanders in the ageing process and the need to ensure society provides its best for those who need our help.

We shouldn't gag the BBC

Newsnight had two stories of child abuse, one they suppressed and one they failed to verify the facts. The result has been a total breakdown in the BBC news department with resignations aplenty and the entire news agenda dominated by the BBC.

Yet we must be careful.

Firstly the fallout at the BBC has obscured the very important issue of systematic and institutional abuse of young people in care, as well as the abuse by celebrities who held a position of trust. And, while the horrendous events reported by Newsnight are described as ‘historic’, the fact remains that abuse can scar people for life, impacting on their lifelong mental health, ability to form relationships etc.

There are still unanswered questions about the events at the homes in North Wales but these questions have been eclipsed by the frenzied call for heads at the BBC. The real story revolves around the original investigation in the early 1990’s yet, it seems, the truth will be buried beneath the bodies of those falling on their swords at the BBC.

In the second instance we need to be careful about this fevered attack on BBC News. After all, what percentage of news output at the BBC do these two Newsnight programmes amount to? Probably very little and we must not frighten BBC News into ‘playing safe’ with such stories in the future.

Without BBC reporting the Winterbourne View abuse could still be going on, elderly people could still be abused in certain care homes etc. Although these were Panorama investigations they still come under the BBC News banner.

We have more to commend BBC News for than we have to dismiss it with the fervour shown by many in high places and we need it to continue to investigate the wrong doings in society and expose abuse wherever it happens. The danger is BBC News producers will become too afraid of the ramifications of being too controversial and facing the wrath of those who disagree.

Newsnight cocked-up yet, if you read the circumstances, they were GIVEN the high profile name, further reading tells us that the victim in question was told that name twenty odd years ago. Reporters should have gone further in verifying the name and that is the only failure causing the BBC frenzy while the real story goes unreported and, possibly, uninvestigated.

The majority of the BBC News output is good, their exposure of injustices must continue and we must not allow this current mistake to stop this.

Cabinet Minister for Social Care: Business Focus

Yesterday the Daily Telegraph revealed that the big care companies have a total debt of £5 billion (http://www.telegraph.co.uk/health/elderhealth/9655229/Britains-biggest-care-home-owners-have-5-billion-debts.html), also yesterday Ed Miliband declared support for the ‘Living Wage’ saying “there are almost five million people in Britain who aren’t earning the living wage” (http://www.labour.org.uk/ed-miliband-speech-on-the-living-wage).

It is probably fair to say that at least one in five of these people are frontline social care workers who are on, or just above, the national minimum wage.

The current minimum wage is £6.19 per hour and the touted living wage is £7.20 per hour, the average pay for a care worker sits neatly in between at £6.65 an hour. So to reach the living wage employers need to find 55p per hour per employee working, on average 40 hours a week for 52 weeks (inc holiday pay) a year. With this applying to over a million people the cost will be around £1.1 billion a year, add into this employers NI contribution etc. and the cost gets higher.

I totally and whole-heartedly agree with the living wage and the benefits of it to social care will be enormous, particularly in terms of recruitment and retention but the real issue is where will the money come from. Most agree that social care funding is in crisis and without promises of extra money to fund the living wage the only place it can come from is existing care services and as noted earlier the debt situation of the bigger care providers hardly suggests that they can afford the living wage whilst maintaining care standards.

Many people easily and comfortably slip in to the idea that social care is a Government run and funded thing yet the reality is, of course quite different. There is no homogenous entity such as the NHS as social care is provided by, according to Skills for Care, approximately 22,100 organisations over 49,700 establishments. Just to put this number in some sort of perspective, the total number of high street bank branches across the UK is just 11,000. This vast, complex myriad of care providers range from the smallest micro-providers to the huge debt-ridden big companies, from not-for-profit voluntary organisations to those owned by offshore parent.

Social care is big business, around 20% of local authority spending in England goes on social care equating to around £21billion per year, so it is no wonder some offshore companies feel there is money to be made, and, of course, this does not include the money paid by those not entitled to local authority support or those who have to pay ‘top-up’ fees to providers.

Yet, despite this seemingly high amount, the payments by local authorities have declined in real terms over the past few years, with eligibility criteria also tightening, and many professionals agreeing that social care needs an urgent injection of real cash to prevent and halt the constant cut back in services.

The business of social care can be as complex as meeting the needs of many individuals who need care services yet everything is the responsibility of a junior minister within the Department of Health.

I truly and honestly believe this needs to change and I would ask you to support my epetition calling for a Cabinet Minister for Social Care - http://epetitions.direct.gov.uk/petitions/39701

The World is Changing, Let's Prepare for the Future

Not strictly a social care blog I will admit, but social care is intrinsically linked hence the reason for putting it here.

The world is changing and, unfortunately, the politicians are failing to acknowledge and address the change that has a huge impact on all levels of society.

We are living longer.

As a result there is a change in the dynamics of society which are only partially addressed by Westminster and, as a result, preparation for the future is woefully short.

Take, for instance, working and the State pension. The age at which the pension can be claimed has risen and will continue to rise over the coming years to mitigate the ever increasing state pension bill. But what notice has been taken of the implications of this? Much is made of the current economic climate, unemployment figures especially among younger people. What we do not here about is the effect of people working longer on the unemployment figures.

It does not take an economist to work out that if people are working longer there are going to be less entry positions available to younger people and where people are working longer the size of the available workforce grows, meaning there is also a need to ensure growth in the number of jobs available otherwise the employment benefit bill will continue to rise.

Ironically, given the current Government approach, one of the areas of employment growth will be needed is in the public sector. As the population ages so will the age related conditions that need to be dealt with by the NHS and its staff, the number of those with dementia will increase dramatically as will other conditions that effect people as they grow older. As the population of the country continues to grow, because of ageing, other public services will need to meet the increasing demand.  It is all very well cutting services to reduce the deficit today but where will that leave us tomorrow?

It is not just politicians that need to adjust to the change in social dynamics. Businesses to need to be aware their customer base is getting older and adjust accordingly. As we age our needs change and it is folly to simply appeal to the younger market (personal bug bear – I do not want skinny jeans but why is it only them available in most shops!), with the high rate of youth unemployment and the fact that people are working longer in life businesses have to consider where the disposable income is!

Institutional ageism has to be halted, older people are now the majority rather than a minority to be sat in the corner and ignored. Some organisations (such as the BBC) have often been accused of ageism (especially with female employees) yet, increasingly their audience have become older people who deserve to be represented.

We are living in an ageing world and as the life expectancy rate continues to grow society will change. Those in charge of policy etc in the country, and, indeed, around the world, need to start changing too, in order to meet the challenges this changing society will bring.

The world is changing, let’s prepare for the future.

Let's Change from ‘Being in a Home’ to Being ‘at Home’.

Do we pay enough attention to the ‘home’ part of care home?

Take a moment to think about what ‘home’ means to you, after all a home is more than just a dwelling place – e.g. house, flat etc. – it is about you. It is the place where you, hopefully, can retreat to, a place filled with memories, a place decked out in the style you like and filled with your things. It is not just a building but a fundamental part of your character and both sociologically and psychologically an important part of your life.

When we go into another person’s home we look around and make judgements about their character, their life, their likes and dislikes etc. and then make judgements on how we feel we will get on with them by making comparisons to our own home.

Yet if it becomes necessary to move a vulnerable person into a care home is there enough thought about the human aspect of a home rather than it just being a ‘placement’.

And what of moving into a care home?

It is well documented that one of life’s greatest stresses is moving home, yes there are the stresses of mortgages, solicitors etc. but the psychological change also creates stress, e.g. how do I create my home in this new house? How do I make it so I am comfortable here?

When a vulnerable person is moved from their home into a care home, for whatever reason, how much thought is given to that transition especially given the additional stresses involved that have forced the need to move in the first place.

Age UK have said that care homes are damaged by a culture of negativity (http://www.ageuk.org.uk/latest-news/care-homes-damaged-by-culture-of-negativity/) and this is certainly true in terms of reports of abusive behaviour and the general perception of care homes as places of ‘last resort’ and while I whole-heartedly agree with the Age UK recommendations I would, perhaps, suggest that we need to add to this the aspect of it being the person’s home and that it is vital that any individual feels ‘at home’.

We can have the most professional, caring staff, but if a person does not feel ‘at home’ there is always going to be difficulty in adjusting to their life in the care home. This may lead to depression, challenging behaviours or just a general malaise and dissatisfaction with life.

How would you feel if you had to live in a place you did not feel comfortable in? Many people have had to because of abusive relationships etc. but for the majority of us can we really comprehend what it is like to have to spend day after day in a place where we did not feel ‘at home’.

There is a need for care homes in the social care system and, in one sense, they should be the ‘last resort’ choice and only consider when it is a danger for a person to live alone and there are no other care alternatives possible. But when it is necessary care homes should not be merely a placement but a real home alternative. Many care homes provide this homely atmosphere yet many do not. Equally those that do may not be the type of home that appeals to the individual and every care should be taken to make sure that the choice of home reflects the individual’s needs, traits and characteristics to ensure the best possible outcomes in their new life.

We need to work to change attitudes, we need to create a new culture of care, we need to change from ‘being in a home’ to being ‘at home’.

Focus on Elderly Care

Over the last four years the number of people receiving council funded adult social care services has fallen by 17.5% and, given that in certain areas such as people with learning disabilities the numbers have increased, the majority of the decline in funded services has hit older people who are targeted under ever tightening eligibility criteria for Local Authority service.

This, of course, flies in the face of what we know about the population in general, the population is increasing and people are living longer so, in fact, we should be seeing an increase in the numbers of people accessing funded social care services, therefore we are seeing a bigger decline in services than the figures initially suggest, even if the numbers were to remain static it would, in real terms, still be a decrease.

Unfortunately much of the policy obsession (obsession used in a limited sense!) is focused on implementing the Dilnot proposals and focused on how much individuals should pay for their care. What this misses is the numbers of people who have no way of paying for their care and are entitled to local authority funded services, the numbers of which are decreasing at an alarming rate despite the fact they should be increasing.

In cases where older people do not meet ‘eligibility’ criteria the role of providing care and support goes to family and friends who, in essence, provide a free service for the state or, if they receive carers allowance, for the princely sum of £58.45 a week (subject to providing a minimum of 35 hours care - so £1.67 per hour!) and many do not receive the allowance because they have an ‘overlapping’ benefit. Research by Carers UK and the University of Leeds shows that, over the past ten years the number of those providing care has increased by 9% with the biggest increase in those aged over 65.

There are costs to looking after someone on a full time basis, particularly when it means giving up full time employment, not only are there the financial implications but also there is evidence of impact on health, well-being and social exclusion. There is help available for carers and many receive local authority assessments but, in terms of the wider social care picture, very little has been done to redress the increasing numbers needed to meet the shortfall in local authority provided services.

Despite these facts the plight of the most needy older people is still being overshadowed by the focus on who pays for care, and while this is important it is only a small part of the overall social care picture.

We need to widen the social care debate at national level which is why I have started an petition call for a Cabinet Minister for social care – I hope  you will take the time to sign  and pass on to others - http://epetitions.direct.gov.uk/petitions/39701

Calling for a Cabinet Minister for Social Care

I have set up an online petition calling for a Cabinet level Minister to be appointed for Social Care (click here) which I hope  you will sign  and which I hope  you will pass on  to friends and colleagues.

Why?

Around one in five of the population is affected by the decisions made by Government on Social Care and given that such a large portion of the country is involved it seems only right that they should have the appropriate representation at the highest level.

I say around 1 in 5 because the figure is hard to estimate and it could well be higher. Carers UK estimate that there are 6.4 million people in the UK providing unpaid care for loved ones (details here) and, naturally, there are a similar amount being cared for. The latest figures from the NHS Information Centre state that there are 1.4 million people in England receiving local authority funded care services, although this figure does not include those receiving continuing care funding from the NHS, additionally these figures are for England only, so the number is increased when the other countries are taken into account. They are then increased further by the unrecorded numbers who fund their own care services.

In addition, the latest figures from Skills for Care tell us that there are 1.6 million paid workers in adult social care. So, in a Nation that has a population of 62 million, one in five may well be a conservative estimate.

At present Social Care is presided over by a junior minister within the Department of Health and, whilst there is no doubt a strong link between health and social care, this fails to encompass the greater range of social care requirements of the people that need social care services.

Social Care is not a homogenous service. It includes services for the elderly, for those with learning disabilities, those with mental health issues or those with physical disabilities, yet, at present all these services are the responsibility of a junior minister.

Social care also encompasses much more than just health services, it includes housing issues, benefit payments, community issues, for those under the age of 65 employment services come into the equation.

As the population ages social care will be a greater part of life with even more people either using or providing services. It is time now for Government to fully recognise social care as a major part of social policy in this country and appoint a Minister to the Cabinet to take responsibility for it.

The e-petition link again - http://epetitions.direct.gov.uk/petitions/39701 I hope  you will  take the time to sign it and that  you will spread the word  to your colleagues and friends

Thank You

Personalisation and Being Human

You would probably agree that there is a part of you that enjoys time alone to relax and reflect yet at times you enjoy the company of others and, if you were being honest with yourself you do, perhaps, enjoy the attention others give you.

Perhaps, at times, you feel that you are not using your full potential in some aspect of your life and that those you are with fail to understand how much more you can offer and improve yourself.

Maybe there is a hidden part of you, one that you can’t reveal to anyone that holds a regret in life, a choice made wrong which, on one hand, is seemingly trivial yet on the other is one that has lived with you for a long time.

We are all the same, and the above holds true for most of us but the degree to which it applies may vary, yet they are fundamental part of our make-up.

Yet do we pay enough attention to these aspects of being human when delivering social care?

Personalisation is the key to delivering good quality social care yet the key to personalisation is understanding what it is to be human and understanding how we tick. Unfortunately the basic training of care work does not include this aspect of understanding which is so vital if quality care is to be universally delivered.

Core training consists of health & safety, infection control, food hygiene, etc. The Skills for Care Common Induction Standards go further but beyond induction training how much training do the majority of care workers get in understanding the individuals they are working with.

There is, of course, a tendency to stereotype people who need social care services (as in all aspects of life) using generic labels such as ‘learning disability’ ‘dementia’ ‘old’ and so on. Such labels have their uses and stereotyping is a human trait which allows us to form our own identity but in delivering care services and treating people with dignity and respect such labels represent just one aspect of who the person is. Although this one aspect may have significant impact on other areas of their life the person who needs social care services is still a person with the many individual quirks, nuances and subtleties that make us all slightly different but with the same underlying aspects of what it is to be human.

Obviously the immediate tool for learning about a person in order to provide personalised care and support is communication. Effective communication is essential, especially about listening to the person about their likes and dislikes but it needs to go further to understand a person’s desires  dreams and hopes. For example if we want to promote a person’s self-esteem we have to understand what that means to the individual, self-esteem involves personal beliefs and emotions not merely the likes and dislikes which are the standard part of any care plan.

Being a person is a complex thing and delivering quality, personalised care and support relies on understanding the individual not merely their personal preferences but also their values and beliefs which form their individuality. Those responsible for delivering care and support services are those on the front line of care and it is essential that their training includes more than the safety and physiological aspects of life.

You would probably agree that if you needed social care services that you would want services that understood what you needed, delivered by people who know when you need company or when you need to be alone, people who knew how to motivate you yet understand when you may be pushed too far, people who understand what dignity and respect mean to you. Isn’t only right then that we should apply this principle to all social care users.

New Ministerial Team MUST Act on Social Care Now

The latest figures from the NHS on council funded care services show, one again, that there has been an overall fall in the numbers of people receiving services. 110,395 less people received services in 2011/2012 a drop of 7%.

At the same time the Royal College of Physicians warn that acute hospital services are on the brink of collapse because of the increasing number of elderly patients, particularly those with dementia, they claim that many feel that older people ‘shouldn’t be there’ and are calling for a redesign of services to better meet patients need (click here for RCP press release).

In other words it appears we are seeing a reduction in community care services resulting in increased pressure on the NHS and this is an issue that needs to be tackled immediately.

This situation is one that can only get worse if left unchecked by the new Ministerial team at the Department of Health.

Kent County Council, for example, are proposing (in their 2013/14 budget consultation) to reduce spending on adult social care by £18m, a cut of 5% and while they claim to be able to do this without harming care services it certainly seems the reduction in council led services is only increasing those in the NHS. Undoubtedly other councils are proposing similar cuts in the adult social care budgets which will lead to more elderly people entering hospital.

The popular press has lead the campaign on who should pay for social care and it seems likely that the Dilnot proposals will be introduced. However this does not solve the issue of how much social care costs and, it seems now, we have some evidence that lack of funding in social care simply transfers the issue to the NHS and, undoubtedly costs the state more in the process.

Care for older people in England, particularly those with dementia, needs to be examined properly and the costs of providing the best possible care acknowledged.

It is only by properly assessing the cost of social care that the issue of who actually pays for it can be sorted.

We have a new Ministerial team in the Department of Health and they must put the care of the most vulnerable in society at the top of the list otherwise the crisis in care will only continue and lead to a greater crisis in health provision.

The Ageing Process Does Not Stop to Wait for Politicians

Just 55 days after the publication of the Social Care White Paper, “Caring for our future: reforming care and support”, social care is once again in a situation of not really knowing what the future is.

The White paper was short on details on funding, after its publication Richard Humphries of the Kings Fund said “Despite its commitment in the “programme for government” to the urgency of reform, the government has failed to produce a clear plan for how care should be funded or a timetable for how these decisions will be considered.” (click here for full press statement).

Then in mid-august we start getting press reports that Prime Minister, David Cameron “has pledged to end the heartache of tens of thousands of elderly people who are forced to sell their homes to fund long-term care” (Daily Mail 16th Aug 2012) by introducing the Dilnot proposals and introducing a £35,000 cap on care costs.

What is unclear is the extent to which the Dilnot proposals will be implemented. The report by Andrew Dilnot applied the cap to care costs not stating that those in care homes should contribute to accommodation and food costs to the tune of £7,000 to £10,000 a year. Given that the current annual state pension is £5,587.40 pensioners in need of care home services would still need to find money from somewhere.

Because of this, as well as the increase in those who will be publicly funded and the greater overhaul of the system that will be needed if the full Dilnot proposals are introduced, the White Paper largely becomes redundant before its consultation period has even ended.

To top this all off the Ministerial architects of the White Paper and draft legislation, Andrew Lansley & Paul Burstow have been shipped out of the Department of Health, and the principle civil servant in creating the paper, David Behan, has now moved to the Care Quality Commission.

Where does this leave the thousands that need social care services, those who care for them, the thousands of workers providing care etc.

Whatever the political reasons for the change of heart about Dilnot and the reshuffling of Ministers we need, NOW, a statement from Number 10 on exactly what is happening, how things stand with the White Paper and draft legislation in order to reassure social care users and the social care sector that there will be no delay in implementing reform. Social care has become all too familiar with the prevarication of politicians and these changes in policy and the personnel delivering it must not be used as an excuse.

We have an ageing population with increasing need for social care services, the ageing process does not stop to wait for politicians so those politicians need to act now for the benefit of people who need care services now.

You Do Not Get Excellence On The Cheap

At a recent press conference Lord Coe said, "You can never spend too much on elite sport. It will always be the greatest driver of sporting participation and we should be unashamed about that.” He went on to say “Of course, you have to have the right structures in place to deal with that demand. Be under no illusion, you do not get excellence on the cheap”

While we are still in the grip of celebrating sporting achievement those words of Lord Coe could resonate throughout any aspect of society not just sport and particularly in social care.

Excellence is always a driver for success, the concept of being a role model is hardly a new one and while the concept may have become something of cliché it remains a fact that we will always try to emulate our heroes or businesses will endeavour to emulate the success of rivals. Unfortunately, in social care, we do not see the success achieved in supporting people to live active and fruitful lives with the support of family or care workers, we do not outwardly demonstrate the excellence of so many care workers dedicated to enhancing the lives of those who can no longer fully participate in society on their own.

Obviously within the sector we do celebrate excellence, primarily through various awards schemes such as the Skills for Care Accolades, yet those celebrations do not extend outwards to the general population and the only view of social care that achieves mainstream coverage is when things go wrong such as the Winterbourne View case. Yet it is only through showing excellence on a wider scale that we can improve recruitment and retention in the sector and inspire people to work in social care.

The Daily Mirror has stated they have found 61,309 jobs in social care (Care for a Change) and, in the current economic climate it seems incredible that so many jobs are available and, let’s be honest, if that many vacancies exist there are some companies struggling to provide a full level of care and support.

To provide the best possible care services we need the best possible care workers and entice the best we need to demonstrate to the wider public the excellence that already exists to inspire people to see social care as a vocation that is rewarding and intensely satisfying. To achieve that we need investment in the social care workforce, we need to move it from the perception of an underpaid, poorly regulated job to a career that promises recognition and gives a sense of pride in working in a sector that is recognised for its contribution to society and the lives of individuals.

The fragmented nature of social care means that the only way this can be achieved on a national level is by the Government coordinating efforts across all of the Local Authorities and the myriad of care providers. The Government needs to invest in social care to ensure a high level of excellence in care provision that will inspire the public and restore faith in the social care system.

Naturally not everything can always be perfect and rogue careers will always enter the system (not unlike drugs cheats who enter sport) but we need to ensure that excellence is highlighted above all else. To achieve this the Government needs to invest in social care – you do not get excellence on the cheap.

Not Long-Term Care But Services for Life

When people think about long term care they often think of the time older people spend in care homes or receive care services at home. They may also consider learning disability care homes but it is unlikely they will consider the true nature of long term care for people with learning disabilities.

People are born with or acquire learning disabilities early in life and, dependent of the nature of the disability need care and support services from that time. With a learning disability other conditions are more prevalent than in the general population, for example autism and epilepsy, which, in turn defines the type of support needed for an individual. In childhood support is needed for education, health etc which is dependent on individual needs and social circumstances and this is followed by transition services which support the individual in the move from child to adult services.

Although ‘adult services’ is the last stop in terms of the catch-all bureaucratic terminology the reality is individuals need support on their journey through life, and their journey is not really any different from the rest of us.

In our twenties and early thirties we are in our physical prime and we reach the pinnacle of physical achievement, obviously that achievement is dependent on lifestyle etc. but it still, for every one of us, it is where we reach the peak and where we are at our fittest. As a general rule we are more ‘immortal’, life’s goals lay ahead of us and achieving our dreams seems easy, old age and death seem so far away as to be almost non-existent. Many people with learning disabilities are not so different and they need support in achieving the goals and dreams and in maintaining their physical well-being.

As we tip over our mid-thirties and head towards the big 50 we start to deteriorate! Obviously we are all individuals and the rate of change varies greatly between people but generally we are not quite as physically fit as our minds think we are! Some people start having mid-life crises while others simply accept that life is moving on and they must move on with it. We become more settled in our lives and readjust our long term aims and ambitions to a more realistic level.

For people with learning disabilities this can be a crucial time of life, many age related conditions that we would normally expect to have in the latter years of our lives can begin to impact on the lives of those with learning disabilities. There are also many social changes for them too. Those who live with parents face issues of their parents becoming older and the possibility of becoming a carer for those who care for them creating a complex co-dependent relationship.

After this point we do come to a split, older peoples services generally start when people reach the age of 65 but way back in the days of Valuing People the government recommend that for people with learning disabilities older peoples services may need to include those aged 50+. Conditions such as dementia can strike much earlier, particularly for those with Down’s Syndrome and issues of continence can also occur earlier than in the general population. As the population is getting older and people with learning disabilities are living longer there are also social issues that need to be supported, people are more likely to lose parents and siblings will take over as primary carers or significant people in providing care and support.

For most of us, as we get older we make adjustments in our lives, we adapt our lifestyles when our health needs change, we find ways of coping when we lose special people in our lives and we adjust our circumstances to what is best for us. We do our best to cope with the extra stresses that ageing can bring.

In other word we LEARN to live with it.

But was happens when the ability to learn is impaired? How easy is it to cope when you don’t fully understand the changes to your body or to your life? That is why it is so important that older people with learning disabilities have the right support as they age, support that will be different from earlier in life.

There is a tendency to focus on older peoples care because of the numbers involved and what is neglected is the fact that many of those with learning disabilities need care and support services for their entire lives and there is a need to recognise the importance of those services alongside those for older people.

Learning disabilities is not about long term care, it is about services for life.

Lets Work to Support Success in Social Care

“Success breeds success” is one of those quotes that we all know but rarely think about what it means yet ‘success’ is big business – just type ‘business success’ into Amazon and see how many thousands of books are available on the subject.

There is some science behind the idea of “success breeds success” for example, Euro 2012: England v Ukraine - The science of home advantage, and while this deals primarily with football the science can apply to many other areas, including social care, especially in learning disability services.

Where the main focus of success is on achieving wealth, power and status the reality is success is any achievement that you make, no matter what level of status it is and success brings about its own rewards. For example, remember back to when you first did something you thought would be impossible, whether it was riding a bike, passing your first exam or baking your first edible cake! Then remember how you felt as you achieved that success, the pride that swelled inside you and the confidence it gave you to undertake that activity again and spur you on to be a little more ambitious next time.

Equally important is what it did to your previous failed attempts at that activity, the pride and feeling of success pushed those failures away from your mind, consigning them to distant memory or erasing them from your mind completely.

In social care services we have many different buzzwords for providing support services and what we want to achieve, we talk about personalisation, independence, outcomes, etc. but, in reality, what we need to talk about is success. We need to support people in becoming successful in independence, personalisation is about achieving success in individual goals and outcomes are only of use if they are successful ones.

I’ve written before about visions, targets and goals in relation to leadership in social care  (http://socialcareinsight.blogspot.co.uk/2012/02/social-care-leadership-visions-targets.html) but the principles also apply to working with individuals to achieve the highest possible level of independence  and these principles are, perhaps, more important in terms of personal support for individuals than anywhere else.

The big vision must always for the individual to lives as independently as possible but to get there people need targets and goals to act as milestones to mark the way to the ultimate goal.  The small ‘wins’ are so important in bolstering confidence and achieving further success, it does not matter how small that success is it helps people understand that success is achievable at any level and spurs them on to achieve the next goal.

The achievement of individual success is also important for people working in learning disability services, if they can support an individual to be successful then they too have achieved success and the same feelings of pride and confidence are imbued in their work.

Success does breed success and we should start talking about achieving success in care services to ensure that helping individuals become successful in their lives is one of the main goals for care providers.

Ministers Need to be Aware of Learning Disability Services

It is Learning Disability week and a great opportunity to raise awareness of the needs of those who have learning disabilities especially as we await the forthcoming White Paper and draft social care bill.

Given the wider debate on social care, particularly around who pays for care it is easy to forget that social care does not solely focus on the elderly and that people with learning disabilities use and need social care services. These services are not exclusively care home services but a wide range of services that have a different focus from elderly care and are vital in helping people live as independently as possible.

The exact number of people with learning disabilities in the UK is not known but what is known is that the numbers of people accessing those services is increasing.

Over the last few years there has been a very small drop in the overall numbers of people accessing council funded services but in those with learning disabilities the number has increased, and quite dramatically with an increase of around 10%. At whilst, relatively speaking, those with learning disabilities are a small percentage of the number of overall numbers of people receiving care services, those services are required over many more years and have an impact on social care provision and funding. Research suggests that about 16% of the total social care budget goes toward learning disability services.

In addition people with learning disabilities are living longer and the rate of longevity is rising faster than that of the general population. Between 2005 and 2010 the numbers of people with learning disabilities over that age of 65 increased by just under 20%. With ageing comes increased need for social care and health services that have to be acknowledged by those on high.

There is, quite rightly, a high focus on dementia and the needs of the elderly but there also needs to be a recognition that learning disability services are different, requiring a care workforce with a different set of skills, knowledge and training that focuses on the different challenges faced by those with learning disabilities.

There needs to be a recognition that ‘Learning Disability’ is a wide ranging catch-all term that encompasses a number of different conditions (and a number of undiagnosed ones) and therefore the number of services needed to meet the needs of the individuals has to be greater than any other aspect of social care.

With the focus on funding elderly care there is a danger that the needs of those with learning disabilities will be passed over by the Government yet the needs of people with learning disabilities are as important as any other group requiring social care services.

Ministers need to be aware of the issues facing learning disability services and ensure that the White Paper and draft Bill reflect those needs.